New study finds strong links between PrEP disruptions and intimate partner violence in Kenya and Uganda. Combined interventions could be key to improving adherence and linking victims to support services.

People who experience intimate partner violence (IPV) are more likely to miss doses of pre-exposure prophylaxis (PrEP), in Kenya and Uganda, according to new findings published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS).

The study, which recruited participants from four sites across Uganda and Kenya where PrEP was being offered to high-risk serodiscordant couples (where one partner is HIV-negative and the other HIV-positive), provides the first insight into the impact of intimate partner violence on PrEP adherence.

Both of the selected countries have high rates of IPV, with recent demographic health surveys finding that 39% of Kenyan women and 9% of men reported experiencing some form of spousal violence. In Uganda 60% of women and 40% of men had experienced partner violence. High IPV prevalence rates such as these, make it important to understand its implications on the HIV epidemic including the efficacy of different prevention methods.

Participants were visited every quarter for up to 24 months. In these visits they were asked if they had experienced any verbal, physical or economic abuse in the last quarter as well as whether during that time they had deliberately decided to take a break from PrEP.

The study found a strong association between reports of IPV and PrEP interruption. PrEP interruptions were reported in 23% of the visits where intimate partner violence was reported and only 6.9% of the visits in which no IPV was reported.

These findings add to a growing body of research showing a deep and multifaceted relationship between HIV and IPV. Already studies have shown that experiences of IPV can increase HIV risk, and negatively affect treatment outcomes. There is also evidence that women living with HIV are more likely to experience IPV.

The researchers suggest that having to explain the reasons for missed doses of PrEP made individuals more likely to come forward about the violence that they were experiencing in their relationship.

The findings suggest that integrating IPV interventions with PrEP adherence services could be important not only for improving PrEP adherence, but also for responding better to cases of IPV.

These suggestions are in-line with new recommendations released by the World Health Organization (WHO) on how health services should respond to cases of IPV. The report states:

“Health services provide a unique resource to identify women subjected to violence, provide them with appropriate care, connect them to other support services and, potentially, contribute to preventing future harm. Ideally, a woman experiencing intimate partner violence should be identified at her first point of contact with health services.”

With the growing use of PrEP in sub-Saharan Africa, check-ups and counselling around adherence will become a bigger part of people’s lives. This means that in the future these services could be the first point of contact that many men and women will have with health services. Recognising interruptions in PrEP as a potential warning sign could play an important role in tackling IPV.